31M with AGA + seb derm: worried I’m late to start finasteride — start now or control scalp first?

General Basic Questions
1

Hi everyone,

I’m 31M. I recently saw a dermatologist and was diagnosed with androgenetic alopecia (AGA) and seborrheic dermatitis.

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My thinning has been gradual for around 4–5 years, mostly on the crown/top. I only recently took consistent photos and realized it had progressed more than I thought.

My dermatologist recommended:

  • Ketoconazole 2% shampoo 3x/week

  • Salicylic acid shampoo 1x/week

  • Minoxidil 5% foam

  • Finasteride was discussed, but I haven’t started it yet

My biggest fear is that I may already be late to start finasteride. I’m wondering whether I should start it as soon as possible, or first focus on controlling seb derm and starting minoxidil.

My questions:

  1. If AGA has been progressing for 4–5 years, is finasteride still worth starting mainly for stabilization?

  2. Is waiting a few more months to start finasteride a bad idea, or is that unlikely to matter much?

  3. Should I start minoxidil first, finasteride first, or both around the same time?

  4. Can minoxidil foam make seb derm/flaking worse?

  5. Is it better to calm scalp inflammation before judging hair-loss treatment?

  6. How worried should I be about finasteride side effects like sexual dysfunction or mood changes?

  7. What should I track over the next 3–6 months to know whether treatment is helping?

I know this is not medical advice, and I’ll keep following up with my dermatologist. I’m mainly looking for a practical treatment framework from people familiar with AGA, minoxidil, finasteride, and seb derm.

2
  1. Fin is definitely worth starting for stabilization despite the progression.
  2. Waiting a few months might not make a big difference, but sooner is better.
  3. You can start fin and min together or separately; starting together might be more efficient.
  4. Min foam can cause irritation sometimes, so watch your scalp.
  5. It’s smart to control seb derm before assessing hair loss treatments fully.
  6. Fin side effects are uncommon, but keep an eye on how you feel.
  7. Track changes with photos and notes on shedding/patterns to measure progress. Check out The Beginner’s Guide for more on treatments.
3

@Henryk Thanks for the reply. Following up on 6. Fin side effects are uncommon, but keep an eye on how you feel.

  1. I saw a dermatologist a few weeks ago and declined finasteride because I didn’t have enough time to research it. After reading more, I’m concerned about post-finasteride syndrome, sexual dysfunction ( planning kid next year) , and possible mood issues. I also read that oral minoxidil may affect blood pressure.

I’m a bit scared and planning a follow-up visit. During my last appointment, it felt like the decision was mostly up to me — whether I was ready to start oral finasteride or not, whether I was ready to start oral min or not?

How concerned should I be before starting it? How should I plan, and what symptoms or changes should I watch for?